<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">

<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta name="description" content="" />
<meta name="keywords" content="" />
<title>Zakat Energy Indonesia</title>
<meta http-equiv="content-type" content="text/html; charset=utf-8" />
<link rel="stylesheet" type="text/css" href="style.css" />
<script type="text/javascript" src="jquery-1.7.1.min.js"></script>
<script type="text/javascript" src="jquery.dropotron-1.0.js"></script>
<script type="text/javascript" src="jquery.slidertron-1.1.js"></script>
<script type="text/javascript">
	$(function() {
		$('#menu > ul').dropotron({
			mode: 'fade',
			globalOffsetY: 11,
			offsetY: -15
		});
	});
</script>
</head>
<body>
	<div class="top_right">
    	&nbsp;&nbsp;&nbsp;<a href=dashboard/login.php>Login</a>&nbsp;&nbsp;|&nbsp;&nbsp;<a href="signup.php">Daftar</a>&nbsp;&nbsp;&nbsp;
	</div>
<div id="wrapper">	
	<div id="header">
    <div id="symbol">
      <img src="images/ZEI.png" alt="" width="133" height="150" /> </div>
		<div id="logo">
			<h1><a href="index.php">Zakat Energy Indonesia</a></h1>
		</div>
		<div id="slogan">
		  <h2>"Karena Berbagi Itu Indah"</h2>
		</div>
  </div>
	<div id="menu">
				<ul>
					<li><a href="index.php">Beranda</a></li>
					<li><a href="zakat.php">Zakat</a></li>
					<li><a href="tentang.php">Tentang Kami</a></li>
					<li><a href="partner.php">Rekanan</a></li>
					<li><a href="kontak.php">Kontak</a></li>
				</ul>
		<br class="clearfix" />
	</div>
	
	<div id="page">
    <div align="center">
    <form action="p_register.php" method="post">
		<table width="863" align="center">
		<tr>
			<td>Username : </td>
			<td><input type=text name=username width="450"></td></tr>         
		<tr>
			<td>Email : </td>
			<td><input type=text name=email width="450"></td></tr>
		<tr>
			<td>Ulangi Email : </td>
			<td><input type=text name=email width="450"></td></tr>
        <tr>
			<td>Password : </td>
			<td><input type=password name=password width="450"></td></tr>
        <tr>
			<td>Nama Lengkap : </td>
			<td><input type=text name=nama width="450"></td></tr>
        <tr>
			<td>Tanggal Lahir : </td>
			<td><input type=date name=ttl> format: dd/mm/yyyy</td></tr>
        <tr>
			<td>Jenis Kelamin : </td>
			<td><input type=radio name=gender value=pria checked="checked">Pria &nbsp;
			<input type=radio name=gender value=wanita>Wanita</td>
			</tr>
        <tr>
			<td>Alamat Lengkap : </td>
			<td><textarea name="alamat" id="comments" rows="5" cols="36" style="width: 301px; height: 76px;"></textarea></td></tr>
        <tr>
			<td>Nomor Telepon : </td>
			<td><input type=text name=telepon></td></tr>
        <tr>
			<td>Mendaftar Sebagai : </td>
			<td><input type=radio name=golongan value=1 checked="checked">Donatur &nbsp;
			<input type=radio name=golongan value=2>Penyalur &nbsp;
			<input type=radio name=golongan value=3>Penerima
			</td>
        <tr>
			<td>No Rekening : </td>
			<td><input type=text name=rekening width="350"></td></tr>
		<tr>
			<td colspan=2 align=center><input type=reset value=Reset>
			<input type=submit value=Submit></td></tr>

		</table>
	</form>
    </div>
    </div>
	
	<div id="page-bottom">
		<div id="page-bottom-content">
			<h3></h3>
			<p>
				
			</p>
		</div>
		<div id="page-bottom-sidebar">
			<!--<h3></h3>
			<ul class="list">
				<li class="first"><a href="#"></a></li>
				<li><a href="#"></a></li>
				<li class="last"><a href="#"></a></li>
			</ul>-->
		</div>
		<br class="clearfix" />
	</div>
</div>
<div id="footer">
	Copyright (c) 2012 zakatenergi.org All rights reserved.</a>.
</div>
</body>
</html>